Comprehensive Primary Care Plus (CPC+)

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What is CPC+?

The Comprehensive Primary Care Plus (CPC+) model is an opportunity for primary care to receive better, more flexible payment and participate in a robust learning community to better meet patient needs. It is an advanced alternative payment model (AAPM) built on learnings from the original CPC initiative.

CPC+ offers two tracks: Track 1 for practices building capabilities or Track 2 for those already delivering advanced primary care.

CPC+ is a multi-payer practice transformation model lead by the Centers for Medicare and Medicaid Services (CMS). It provides primary care practices with up-front and improved payment along with technical assistance. Implementation of CPC+ began January 1, 2017 with 2,891 primary care practices participating in 14 regions. This first group of practices and regions is referred to as Round 1.

A second group of up to 1,000 practices will make up Round 2 of CPC+. Round 2 will begin on January 1, 2018, in four regions. Practices located in these new regions were eligible to apply until July 13, 2017. Selected practices for Round 2 will be announced in fall 2017.

About the CPC+ Model

The CPC+ payment model is beneficial for primary care. It provides access to increased and up-front payment for primary care. CPC+ has three components that de-emphasize fee-for-service and increase payment to support practice improvement and capacity building. Both CPC+ tracks offer three payment components:

Care management fee (CMF): Practices will receive a per-beneficiary-per-month (PBPM) CMF for their Medicare Part B patients. The fee will be paid prospectively on a quarterly basis and will be based on the complexity of the patient population. The average PBPM CMF will be $15 for Track 1 and $28 for Track 2. Track 2 practices will receive a $100 PBPM CMF for the most complex cases, such as patients with dementia.

Performance-based incentive payment (PBIP): All CPC+ practices receive their PBIP as a prospective payment at the beginning of each program year in order to meet patient needs and build capacity. At the end of the program year, practices that do not meet quality and cost benchmarks will repay some or all of this payment. The PBIP will be equivalent to $2.50 PBPM for Track 1 and $4 PBPM for Track 2.

CPC+ practices receive technical assistance and support through national and regional learning contractors and are able to connect with and learn from other CPC+ practices through an online platform.

Within the Quality Payment Program (QPP), CPC+ has been designated as an Advanced Alternative Payment model (AAPM). For the 2017 performance period, an AAPM entity must do one of the following for all of its eligible clinicians to be qualifying participants (QPs):

Receive at least 25% of its MEdicare Part B payments through AAPM, or

See at least 20% of its Medicare patients through the AAPM

QPs will receive an annual 5% lump sum bonus. The bonus applies in payment years 2019-2024.

QPs will be excluded from the MIPS reporting requirements.

QPs will receive a 0.75% increase to their Medicare physician fee schedule (PFS) beginning in 2026.

AAPM entities that do not meet either the payment threshold or the patient threshold can opt to participate in MIPS and will be scored using the APM Scoring Standard.

For Round 1, practices of any size that meet the QP threshold are eligible for the lump sum bonus. For Round 2, practices whose TIN has 50 of fewer clinicians and meets the QP threshold are eligible for the lump sum bonus.

CPC+ Round 1

In order to assure the integrity of the evaluation, new practices cannot join those existing regions. CPC+ Round 1 is currently being implemented in the following states and regions:

CPC+ Round 2

Round 2 is being implemented in the four regions below. Applications for Round 2 were due July 13, 2017, and selected practices will be announced in fall 2017. Eligible practices applying in Round 2 regions may be assigned to a comparison group to evaluate and build evidence for the CPC+ model. More about the comparison group expectations can be found on pages 3 and 20 of the CMS Practice FAQ(innovation.cms.gov).